Talking About Glaucoma (TAG) AAC - WholeLottaRobhttp://wholelottarob.com/tag-aac/Mon, 05 Nov 2018 05:53:23 +0000en-USSite-Server v6.0.0-16734-16734 (http://www.squarespace.com)Robert M Schertzer, MD, MEd, FRCSCPodcast of indeterminate frequency talking about glaucoma with colleagues (AAC .m4a version)The MP3 version lacks enhanced content found on the full (AAC) version but works on legacy devices.The MP3 version lacks enhanced content found on the full (AAC) version but works on legacy devices.noRobert M Schertzer, MD, MEd, FRCSCiguy@iguy.orgTAG Episode 30 - 5Nov2018 JOHNSTONE Murray Pulsatile Flow (AAC)GlaucomaPodcastRob SchertzerTue, 06 Nov 2018 01:14:24 +0000http://wholelottarob.com/tag-aac/2018/11/5/tag-episode-30-5nov2018-johnstone-murray-pulsatile-flow-aac5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:5bdfdad32b6a28f99146505aIn this episode, I talk with Murray Johnstone from Seattle about pulsatile
flow through the Trabecular Meshwork and collector channels. We discuss the
imaging improvements over the years that have made this possible including
the latest phase-based OCT scans that result in nanometre resolution
instead of the micrometre resolution of spectral domain scans that most of
us are using in clinical practice.Intro:

[This is the AAC version. Starting with Episode 30, aside from minor sound quality differences, there is no longer a difference between the AAC and MP3 versions of my podcast. The additional artwork and chapter markers have been too time consuming and have not really been noticed by anyone! Enjoy the show.]

Murray Johnstone, MD

Welcome back to Talking About Glaucoma, a podcast of indeterminate length and frequency. I’m your host Robert Schertzer, a Glaucoma Specialist from Vancouver, BC Canada. To help produce future shows more frequently, I will no longer include artwork and chapter markings. Hopefully this will get me back on track to publishing new episodes each month this coming year. As always, contact me at podcast@iguy.org if you have a glaucoma topic that you would like to discuss with me on a future episode.

In this episode, I talk with Murray Johnstone from Seattle about pulsatile flow through the Trabecular Meshwork and collector channels. We discuss the imaging improvements over the years that have made this possible including the latest phase-based OCT scans that result in nanometre resolution instead of the micrometre resolution of spectral domain scans that most of us are using in clinical practice.

I’m Rob Schertzer and we’re….talking about glaucoma.

Show Notes:

This topic spans decades of work that began prior to his fellowship and resumed around the year 2000 as the imaging technology began to become available to prove the theory. Aqueous outflow drugs increase the outflow pulsatility, not just flow. Goldmann thought the TM was rigid preventing he and Asher from being able to explain the pulsatile nature of the flow. The ocular pulse drives movement of the TM, which is not rigid. The drugs that improve outflow, do so by altering the blood flow to achieve their effect. This is literally a stroke volume.

The theoretical sensitivity to motion is in picometer with the newer phase-based OCTs, that of the movement of electrons in an atom, though practically we achieve nanometer resolution. This is sensitivity of motion of the TM walls, and not the resolution of an image.

How does this flow vary by location within the angle and from moment to moment? This is a live dynamic process. They have published numerous studies in both normal and abnormal outflow patients. Questions to answer include how this flow is altered by laser, meds, stent procedures? Does the act of doing the measurements also alter the flow? It is non-contact and non-invasive therefore should not be altering the flow but white-coat syndrome could have an influence. Perhaps in the future, we can instill a drop in the patient’s eye, measure the change in pulsatile flow, and be able to tell whether a particular medication will actually be effective.

We measure 12 seconds of 31 million seconds in a patient’s year when we check IOP several times per year. By determining pulsatile outflow we have the potential to achieve new diagnostic and treatment options for our patients. This is analogous to how cardiology is using imaging modalities in patient care.

iTunes Subtitle:

A discussion about Pulsatile Flow through the trabecular meshwork and collector channels with Murray Johnstone.

iTunes Summary:

I sat down with Murray Johnstone at a recent American Glaucoma Society meeting to discuss Pulsatile Flow through the trabecular meshwork and collector channels of the eye. Medications that enhance aqueous outflow in glaucoma in fact improves the pulsatile stroke volume.

Production information:

This episode was originally recorded March 2016 during the Annual Meeting of the American Glaucoma Society in Ft Lauderdale using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were FINALLY completed in November 2018 on a MacBook Pro and an iMac using Hindenberg Journalist Pro software. There was a great deal of background noise requiring generous use of noise gate and compression filters, with reverb added back to bring the voices back to life. Narration was overdubbed using a Blue Yeti Microphone with Journalist Pro.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

Closing remarks:

That’s our show for today. Thanks for your patience as I slowly post new episodes including a talk about the new glaucoma drug Rhopressa. Please rate this show on iTunes as this is the best way for other people to find the show.

You can subscribe using iTunes, PocketCasts, GooglePlay, Stitcher or wherever fine podcasts are found, and new episodes will appear in your podcast player as they come out. Please tell your friends and colleagues about the show.

]]>Murray Johnstone & Rob SchertzerThe pulsatile nature of flow through the Trabecular Meshwork and collector channels.In this episode, I talk with Murray Johnstone from Seattle about pulsatile flow through the Trabecular Meshwork and collector channels. We discuss the imaging improvements over the years that have made this possible including the latest phase-based OCT scans that result in nanometre resolution instead of the micrometre resolution of spectral domain scans that most of us are using in clinical practice.no00:35:0830Talking About Glaucoma #30 - 5Nov2018 JOHNSTONE Murray Pulsatile Flow (AAC)fullIntro:

Welcome back to Talking About Glaucoma, a podcast of indeterminate length and frequency. I’m your host Robert Schertzer, a Glaucoma Specialist from Vancouver, BC Canada. To help produce future shows more frequently, I will no longer include artwork and chapter markings. Hopefully this will get me back on track to publishing new episodes each month this coming year. As always, contact me at podcast@iguy.org if you have a glaucoma topic that you would like to discuss with me on a future episode.

In this episode, I talk with Murray Johnstone from Seattle about pulsatile flow through the Trabecular Meshwork and collector channels. We discuss the imaging improvements over the years that have made this possible including the latest phase-based OCT scans that result in nanometre resolution instead of the micrometre resolution of spectral domain scans that most of us are using in clinical practice.

Show Notes:

This topic spans decades of work that began prior to his fellowship and resumed around the year 2000 as the imaging technology began to become available to prove the theory. Aqueous outflow drugs increase the outflow pulsatility, not just flow. Goldmann thought the TM was rigid preventing he and Asher from being able to explain the pulsatile nature of the flow. The ocular pulse drives movement of the TM, which is not rigid. The drugs that improve outflow, do so by altering the blood flow to achieve their effect. This is literally a stroke volume.

The theoretical sensitivity to motion is in picometer with the newer phase-based OCTs, that of the movement of electrons in an atom, though practically we achieve nanometer resolution. This is sensitivity of motion of the TM walls, and not the resolution of an image.

How does this flow vary by location within the angle and from moment to moment? This is a live dynamic process. They have published numerous studies in both normal and abnormal outflow patients. Questions to answer include how this flow is altered by laser, meds, stent procedures? Does the act of doing the measurements also alter the flow? It is non-contact and non-invasive therefore should not be altering the flow but white-coat syndrome could have an influence. Perhaps in the future, we can instill a drop in the patient’s eye, measure the change in pulsatile flow, and be able to tell whether a particular medication will actually be effective.

We measure 12 seconds of 31 million seconds in a patient’s year when we check IOP several times per year. By determining pulsatile outflow we have the potential to achieve new diagnostic and treatment options for our patients. This is analogous to how cardiology is using imaging modalities in patient care.

This episode was originally recorded March 2016 during the Annual Meeting of the American Glaucoma Society in Ft Lauderdale using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were FINALLY completed in November 2018 on a MacBook Pro and an iMac using Hindenberg Journalist Pro software. There was a great deal of background noise requiring generous use of noise gate and compression filters, with reverb added back to bring the voices back to life. Narration was overdubbed using a Blue Yeti Microphone with Journalist Pro.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

That’s our show for today. Thanks for your patience as I slowly post new episodes including a talk about the new glaucoma drug Rhopressa. Please rate this show on iTunes as this is the best way for other people to find the show.

You can subscribe using iTunes, PocketCasts, GooglePlay, Stitcher or wherever fine podcasts are found, and new episodes will appear in your podcast player as they come out. Please tell your friends and colleagues about the show.

Drop me a line at podcast@iguy.org with your comments, visit WholeLottaRob.com, WestCoastGlaucoma.com, or follow me on twitter @robschertzer. Links to all of these are in the show notes. Remember to keep fighting glaucoma by early detection so that nobody loses vision from this group of diseases.

[This AAC .m4a version has chapter markers and artwork embedded in the podcast to enhance the experience on devices/apps that support this, which includes most podcasting apps on iOS and Android devices. It is the preferred version for experiencing this podcast.]

In this episode, I’m talking with Ron Fellman from Glaucoma Associates of Texas about the Fellman Fluid Wave and its clinical implications in glaucoma surgery.

Episode Chapters:

Intro: Ron Fellman

Glaucoma Associates of Texas

Fluid Wave: what it is

Related strictly to conventional outflow

Evidence of patency of this system

When unroofing Schlemm’s canal a decade ago when viscocanalostomy was being popularized, injecting BSS you could see the outflow pathways

At times there would be no flow into the adjacent veins

Was I in the wrong spot?

Five years ago during Trabectome, wondered if the outflow could be visualized

Reduced the Episcleral Venous Pressure by putting patient into some raverse Trandelenberg and raised the bottle height to its highest

You don’t see this during normal phacoemulsification because usually you are forcing the Schlemm’s canal closed

How does the fluid get to the episclera?

In Trabectome, adjacent to the tip, can see segmental fluid outflow if focus at the limbus; first let foot off the foot-pedal to drop the eye pressure and look for blood to reflux in to AC, then floor the pedal and if there’s a connection through to the collector channel, then the fluid gets through the episclera via deep venous plex, mid venous plexus and then to the episcleral venous plexus super highway

Blanching is occurring as all the blood runs out of the tissue

Improve outflow where there isn’t or optimize existing flow?

Aqueous wants to go out the path of least resistance

If you see a blanching it means the deep and mid venous plexus are both open and this is where the trabectome will work the best

The blanching correlates best with the patients with the lowest IOP; averaging 11.9 on 1 med vs 19 on 3 meds

Zero re-op on those with good flow vs 36% in patients with a poor wave seen intra-operatively

However we still don’t have a way to modulate wound healing with a trabectome; so can still get granulation tissue that ruins the surgery

Would fluid wave work for other MIGS procedures?

With circumferential sclerotomy see a near uniform fluid wave

With an iStent if you hit the right spot, usually won’t see more than 1 or 2 clock hours of a fluid wave; and this would only be seen AFTER the iStent is in place so you can’t do this BEFORE putting in the iStent

What’s the outcome marker for MIGS surgery? With Trab, its bleb formulation; with MIGS don’t see something when the case ends

This episode was originally recorded March 2016 during the Annual Meeting of the American Glaucoma Society in Ft Lauderdale using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were FINALLY completed in January 2018 on an iMac using Hindenberg Journalist Pro software. Narration was overdubbed using a Blue Yeti Microphone with Journalist Pro.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

Future episodes include a long discussion with Murray Johnstone and a talk about the new glaucoma drug Rhopressa.

If you subscribe via iTunes, PocketCasts, GooglePlay, Stitcher or wherever fine podcasts are found, you will get the new episodes as they come out. If you like the show, please leave a rating on iTunes as this is the best way for others to find it and tell your friends about the show.

]]>Ron Fellman & Rob SchertzerA discussion about the fluid wave in aqueous humour outflow with Ron Fellman.I sat down with Ron Fellman at a recent American Glaucoma Society meeting to discuss the use of the fluid wave in assessing the aqueous humour outflow pathway and its clinical application.no00:19:3529Talking About Glaucoma #29 - 29Jan2018 FELLMAN Fluid Wave (AAC)fullIn this episode, I’m talking with Ron Fellman from Glaucoma Associates of Texas about the Fellman Fluid Wave and its clinical implications in glaucoma surgery.

Episode Chapters:

Intro: Ron Fellman

Glaucoma Associates of Texas

Fluid Wave: what it isRelated strictly to conventional outflow

Evidence of patency of this system

When unroofing Schlemm’s canal a decade ago when viscocanalostomy was being popularized, injecting BSS you could see the outflow pathways

At times there would be no flow into the adjacent veins

Was I in the wrong spot?

Five years ago during Trabectome, wondered if the outflow could be visualized

Reduced the Episcleral Venous Pressure by putting patient into some raverse Trandelenberg and raised the bottle height to its highest

You don’t see this during normal phacoemulsification because usually you are forcing the Schlemm’s canal closed

How does the fluid get to the episclera?

In Trabectome, adjacent to the tip, can see segmental fluid outflow if focus at the limbus; first let foot off the foot-pedal to drop the eye pressure and look for blood to reflux in to AC, then floor the pedal and if there’s a connection through to the collector channel, then the fluid gets through the episclera via deep venous plex, mid venous plexus and then to the episcleral venous plexus super highway

Blanching is occurring as all the blood runs out of the tissue

Improve outflow where there isn’t or optimize existing flow?

Aqueous wants to go out the path of least resistance

If you see a blanching it means the deep and mid venous plexus are both open and this is where the trabectome will work the best

The blanching correlates best with the patients with the lowest IOP; averaging 11.9 on 1 med vs 19 on 3 meds

Zero re-op on those with good flow vs 36% in patients with a poor wave seen intra-operatively

However we still don’t have a way to modulate wound healing with a trabectome; so can still get granulation tissue that ruins the surgery

Would fluid wave work for other MIGS procedures?

With circumferential sclerotomy see a near uniform fluid wave

With an iStent if you hit the right spot, usually won’t see more than 1 or 2 clock hours of a fluid wave; and this would only be seen AFTER the iStent is in place so you can’t do this BEFORE putting in the iStent

What’s the outcome marker for MIGS surgery? With Trab, its bleb formulation; with MIGS don’t see something when the case ends

Reference:

Episcleral Venous Fluid Wave: Intraoperative Evidence for Patency of the Conventional Outflow System

This episode was originally recorded March 2016 during the Annual Meeting of the American Glaucoma Society in Ft Lauderdale using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were FINALLY completed in January 2018 on an iMac using Hindenberg Journalist Pro software. Narration was overdubbed using a Blue Yeti Microphone with Journalist Pro.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

Future episodes include a long discussion with Murray Johnstone and a talk about the new glaucoma drug Rhopressa.

If you subscribe via iTunes, PocketCasts, GooglePlay, Stitcher or wherever fine podcasts are found, you will get the new episodes as they come out. If you like the show, please leave a rating on iTunes as this is the best way for others to find it and tell your friends about the show.

]]>Talking About Glaucoma #29 - 29Jan2018 FELLMAN Fluid Wave (AAC)TAG Episode 28 - 18July2017: JOHNSON pet peeves in perimetry (AAC Enhanced)GlaucomaPodcastRob SchertzerWed, 19 Jul 2017 02:05:06 +0000http://wholelottarob.com/tag-aac/2017/7/17/tag-episode-28-18july2017-johnson-pet-peeves-in-perimetry-aac-enhanced5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:596cf53659cc68a2a94a5c50I sat down with Chris Johnson at a recent American Glaucoma Society meeting
to discuss some of my pet peeves about visual field testing and what lies
on the horizon. Chris is Professor of Ophthalmology and Visual Sciences at
the University of Iowa and a world renown Perimetry expert.[This AAC .m4a version has chapter markers and artwork embedded in the podcast to enhance the experience on devices/apps that support this, which includes most podcasting apps on iOS and Android devices. It is the preferred version for experiencing this podcast.]

I sat down with Chris Johnson at a recent American Glaucoma Society meeting to discuss some of my pet peeves about visual field testing and what lies on the horizon. Chris is Professor of Ophthalmology and Visual Sciences at the University of Iowa and a world renown Perimetry expert.

Episode Chapters:

1. Myopic tilted optic nerves; do we have a proper control group to compare these patients to? Liquid lens in HVF 3 corrects for spherical refractive error. Nasal steps often spill over the horizontal midline because we do not correct for tilt. SLO with microperimetry will compensate for this, not yet released at the time of this recording but is now available outside of North America e.g. Compass (Fundus Automated Perimetry) https://www.centervue.com/products/compass/

2. Flattening of Frequency of Seeing curve as defects gets worse, the VF gets less reliable because we don’t use bigger test targets when worse; i.e. the more damage, the higher the variability. Aside from increasing target size e.g. a size VI target, there is potential with Frequency Doubling perimetry to reduce this variability

5. Reached a plateau and now that imaging has been advancing, it’s time for a paradigm shift that correlates the structure and function

Production information:

This episode was originally recorded March 2015 during the Annual Meeting of the American Glaucoma Society in Coronado, CA using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were FINALLY performed in July 2017 on a MacPro using Hindenberg Journalist Pro software. Narration was overdubbed using a Heil PR40 Microphone with Journalist Pro. Look for upcoming discussion with Ron Fellman and Murray Johnstone that were recorded in 2016 that are still sitting in the vault and then some new recordings are planned soon.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

]]>Chris Johnson & Rob SchertzerA discussion of some of my pet peeves in Visual Field testing as well as a glimpse into what lies beyond the horizon.I sat down with Chris Johsnon at a recent American Glaucoma Society meeting to discuss some of my pet peeves about visual field testing and what lies on the horizon. Chris is Professor of Ophthalmology and Visual Sciences at the University of Iowa and a world renown Perimetry expert.no00:16:00TAG Episode 27 - 1Mar2017: Harbin Ethics in Medical Tx (AAC Enhanced)GlaucomaPodcastRob SchertzerThu, 02 Mar 2017 08:26:43 +0000http://wholelottarob.com/tag-aac/2017/3/1/tag-episode-27-1mar2017-harbin-ethics-in-medical-tx5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:58b798cf2994cae144d1797bIn this episode, Tom Harbin, from Eye Consultants of Atlanta, and I discuss
ethical issues in the medical treatment of glaucoma. This includes generic
vs brand name drugs, the need to shop around for the best price, and
looking out for talks from so-called Key Opinion Leaders.[This AAC .m4a version has chapter markers and artwork embedded in the podcast to enhance the experience on devices/apps that support this, which includes most podcasting apps on iOS and Android devices. It is the preferred version for experiencing this podcast.]

Tom Harbin, MD

In this episode, Tom Harbin, from Eye Consultants of Atlanta, and I discuss ethical issues in the medical treatment of glaucoma. This includes generic vs brand name drugs, the need to shop around for the best price, and looking out for talks from so-called Key Opinion Leaders.

--------------------------------------------------

Production information:

This episode was recorded live in March 2014 during the Annual Meeting of the American Glaucoma Society in Washington, DC using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were FINALLY performed in February/March 2017 on a MacBook Pro using Levelator, and Hindenberg Journalist Pro software. Narration was overdubbed using a Heil PR40 and Audio Technica ATR2100 USB Microphone with Journalist Pro. This completes my transition from Garage Band to Hindenberg Journalist Pro which allows me to edit these shows cross-platform and hopefully will help me get episodes out more quickly like the three still awaiting release with Chris Johnson, Ron Fellman and Murray Johnstone that were recorded in 2016.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.--------------------------------------------------Tom Harbin, MD, MBAEye Consultants of Atlantahttp://eyeconsultants.nethttp://tomharbin.comWaking Up Blind (from Amazon.com)Tom Harbin discloses that he has a financial interest in the sale of his bookTomHarbin@comcast.net--------------------------------------------------Robert M Schertzer, MD, MEd, FRCSCpodcast@iguy.org

]]>Tom Harbin & Rob SchertzerEthical issues in prescribing medical therapy for glaucomaIn this episode, Tom Harbin, from Eye Consultants of Atlanta, and I discuss ethical issues in the medical treatment of glaucoma. This includes generic vs brand name drugs, the need to shop around for the best price, and looking out for talks from so-called Key Opinion Leaders.no00:16:29TAG Episode 26 - 29Jan2017: Wright Tx to Outcome Gap (AAC enhanced)Rob SchertzerSun, 29 Jan 2017 12:47:03 +0000http://wholelottarob.com/tag-aac/2017/1/27/tag-episode-26-28jan2017-wright-tx-to-outcome-gap5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:588b71aeb8a79bc9353fa504In this episode, I talk with Tracy Wright, now based at Kaiser Permanente
in Washington DC. He was at the Bascom Palmer Eye Institute at the
University of Miami when we recorded this conversation. The implications
immediately effected how I look at visual fields. The findings you are
about to here may be shocking...[This AAC .m4a version has chapter markers and artwork embedded in the podcast to enhance the experience on devices/apps that support this, which includes most podcasting apps on iOS and Android devices. It is the preferred version for experiencing this podcast.]

Tracy Wright, MD

In this episode, I talk with Tracy Wright, now based at Kaiser Permanente in Washington DC. He was at the Bascom Palmer Eye Institute at the University of Miami when we recorded this conversation. The implications immediately effected how I look at visual fields in my patients but I have yet to see further studies that support what we discussed, namely that visual fields continue to progress for a long time even once the stimulus that led to the initial glaucoma damage has been removed, likely due to apoptosis. The findings you are about to here may be shocking. Please write to me with your comments.--------------------------------------------------

Production information:

This episode was recorded live in March 2014 during the Annual Meeting of the American Glaucoma Society in Washington, DC using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were FINALLY performed in January 2017 on a MacBook Pro using Levelator, and Hindenberg Journalist Pro software. Narration was overdubbed using a Heil PR40 Microphone with Journalist Pro.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.--------------------------------------------------

This episode was recorded live in March 2015 during the Annual Meeting of the American Glaucoma Society in Coronado, CA, using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were performed in February 2016 on a MacBook Pro and MacPro using Levelator, Fission, and Garage Band. Narration was overdubbed using a Blue YETI Microphone and Garage Band.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.--------------------------------------------------

]]>Nelson Winkler, Cheryl Khanna, & Robert SchertzerAnalysis of the outcome of a physician-led team based approach to glaucoma careIn this episode, I talk with Nelson Winkler (a medical student at the time) and Cheryl Khanna (Glaucoma attending) at The Mayo Clinic, who analyzed the outcomes of their team based model for Glaucoma care. This physician- led model began in 2008 and has Ophthalmologists working together with Optometrists to deliver glaucoma care. With specific definitions for progression of the disease, patients are referred back to Ophthalmology at critical points or every two years if stable. This model was born out of necessity as they have just two glaucoma sub-specialists to care for a large patient population. It has allowed better allocation of resources so that patients who really need the glaucoma subspecialty care are not over-loaded with patients who are clearly stable.no00:13:45TAG Episode 24 - 30Aug2015: Suman Thapa Delivery of Glaucoma Care in Nepal(AAC Enhanced)Rob SchertzerMon, 31 Aug 2015 14:10:30 +0000http://wholelottarob.com/tag-aac/2015/8/30/tag-episode-24-30aug2015-suman-thapa-delivering-glaucoma-care-in-nepalaac-enhanced5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:55e3b3dbe4b0fbac6880cfd7In this episode, I talk with Suman Thapa about delivering glaucoma care in
Nepal. This conversation took place long before the two massive earthquakes
in 2015. I am happy to see that Suman is back at work caring for patients.[This AAC .m4a version has chapter markers and artwork embedded in the podcast to enhance the experience on devices/apps that support this, which includes most podcasting apps on iOS and Android devices. It is the preferred version for experiencing this podcast.]

In this episode, I talk with Suman Thapa about delivering glaucoma care in Nepal. This conversation took place long before the two massive earthquakes in 2015. I am happy to see that Suman is back at work caring for patients.

This episode was recorded live in March 2012 during the Glaucoma Today 2012 conference in Tel Aviv, Israel, using a Shure SM58 microphone with a Marantz PMD661 digital recorder. Mixing and sound levelling were performed in February 2014 thru August 2015 on a MacBook Pro and MacPro using Levelator, Fission, and Garage Band. Narration was overdubbed using a Heil PR40 Microphone and Garage Band.

Opinions expressed in this podcastare those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

]]>Suman Thapa & Rob SchertzerThe challenges in delivering glaucoma care to remote villages[This AAC .m4a version has chapter markers and artwork embedded in the podcast to enhance the experience on devices/apps that support this, which includes most podcasting apps on iOS and Android devices. It is the preferred version for experiencing this podcast.] In this episode, I talk with Suman Thapa about delivering glaucoma care in Nepal. This conversation took place long before the two massive earthquakes in 2015. I am happy to see that Suman is back at work caring for patients.no00:17:31TAG Episode 23 - 3Nov2014: ab-interno trabecular bypass surgery (AAC Enhanced)GlaucomaPodcastRob SchertzerMon, 03 Nov 2014 01:35:18 +0000http://wholelottarob.com/tag-aac/2014/11/2/tag-episode-23-3nov2014-ab-interno-trabecular-bypass-surgery-aac-enhanced5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:5456c2bae4b01b6bc4aaa2c0In this episode, Tom Samuelson and I discuss trabecular bypass procedures
including the currently available & two future models of the iStent, and
the Ivantis Hydrus Microstent. There is a tendency for doctors to prescribe
third and fourth glaucoma medications even though it is well known that
there is such a diminishing return after two medications. These ab-interno
devices can serve as a glaucoma-lite procedure, the next step after two
medications for those reluctant to proceed with a potentially more
effective but more risky trabeculectomy. The use of multiple iStents, next
generation devices, or targeting delivery to visualized collector ducts
should lead to improvements in ab-interno trabecular bypass procedures in
the years ahead.[This AAC .m4a version has chapter markers and artwork embedded in the podcast to enhance the experience on devices/apps that support this, which includes most podcasting apps on iOS and Android devices. It is the preferred version for experiencing this podcast.]

In this episode, Tom Samuelson and I discuss trabecular bypass procedures including the currently available & two future models of the iStent, and the Ivantis Hydrus Microstent. With iStent being the only currently FDA approved ab-interno trabecular bypass device, it is anticipated that the first generation iStent will serve as the control for future devices much like timolol is the standard to which all new glaucoma drugs are compared. There is a tendency for doctors to prescribe third and fourth glaucoma medications even though it is well known that there is such a diminishing return after two medications. These ab-interno devices can serve as a glaucoma-lite procedure, the next step after two medications for those reluctant to proceed with a potentially more effective but more risky trabeculectomy. With the iStent as it is currently approved in the United States (a single iStent and only combined with cataract surgery), it is hit or miss whether you actually reach a collector channel on the other side. The Hydrus, being 8 mm long instead of just 1 mm, is much more ikely to lead to outflow through a collector channel. The use of multiple iStents, next generation devices, or targeting delivery to visualized collector ducts should lead to improvements in ab-interno trabecular bypass procedures in the years ahead.

Even though this episode was originally recorded almost 1.5 years ago and I've only edited and posted today, no other devices aside from the 1st generation iStent have made it to market at this time so the material is all still relevant. Thanks to my listeners for sticking with me despite the paucity of episodes. I still have at least five more to edit and post and am always looking for new material if any glaucoma specialists want to talk. Please contact me at podcast@iguy.org. (Rob Schertzer, MD, MEd, FRCSC)

--------------------------------------------------Thomas W. Samuelson is an adjunct associate pofessor of ophthalmology at the University of Minnesota and past chairman of the medical staff at the Phillips Eye Institute in Minneapolis. He is a faculty member at Hennepin County Medical Center, a major teaching hospital for the University of Minnesota residency program. On a national level, Dr. Samuelson is the recipient of the American Academy of Ophthalmology's Senior Achievement Award honoring contributions made to the Academy's educational programs.

Dr. Samuelson is the current Treasurer for the American Glaucoma Society and serves on its Executive Committee. He also oversees the glaucoma skills transfer courses for the American Academy of Ophthalmology (AAO). He serves on the Basic Clinical Science Course Committee for the AAO. Dr. Samuelson also serves as editorial board member and scientific reviewer for several ophthalmology journals.

Dr. Samuelson’s research interests include surgical procedures involving Schlemm’s Canal as well as the management of coincident cataract and glaucoma. He has also performed research on the safety of LASIK in patients with other ocular disorders, especially glaucoma. A frequent lecturer nationally and internationally (keynote lectures) on ocular surgery, he has published numerous scientific manuscripts and textbook chapters on ophthalmic surgery.

This episode was recorded live in March 2013 during the American Glaucoma Society annual meeting in San Francisco using a Shure SM58 microphone with a Marantz PMD661 digital recorder. Mixing and sound levelling were performed in November 2014 on a MacPro, using Levelator, Fission, and Garage Band. Narration was overdubbed using a Blue Microphone Yeti and Garage Band.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.--------------------------------------------------Selected references:

]]>Tom Samuelson & Rob SchertzerAn interim step instead of a 3rd or 4th glaucoma medication when patients are not quite ready for more invasive surgery.[This AAC .m4a version has chapter markers and artwork embedded in the podcast to enhance the experience on devices/apps that support this, which includes most podcasting apps on iOS and Android devices. It is the preferred version for experiencing this podcast.] In this episode, Tom Samuelson and I discuss trabecular bypass procedures including the currently available & two future models of the iStent, and the Ivantis Hydrus Microstent. There is a tendency for doctors to prescribe third and fourth glaucoma medications even though it is well known that there is such a diminishing return after two medications. These ab-interno devices can serve as a glaucoma-lite procedure, the next step after two medications for those reluctant to proceed with a potentially more effective but more risky trabeculectomy. The use of multiple iStents, next generation devices, or targeting delivery to visualized collector ducts should lead to improvements in ab-interno trabecular bypass procedures in the years ahead.no00:15:40TAG Episode 22 - 6Feb2014: HiFU Therapy (AAC Enhanced)Rob SchertzerThu, 06 Feb 2014 22:17:06 +0000http://wholelottarob.com/tag-aac/2014/2/4/tag-episode-22-5feb2014-hifu-therapy-aac-enhanced5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:52f143fae4b02fdbc0957634In this episode, I talk with Florent Aptel, a glaucoma specialist in
Grenoble, France, about his work in developing a modern day hi frequency
ultrasound as a treatment for glaucoma in its early stages. Their group has
developed a device that selectively focuses the energy on the ciliary body
without collateral damage that offers hope as a future treatment modality.After almost a full year off the air during which time I relocated from Vancouver, BC to Hanover, NH I am working on catching up with editing and posting episodes that I've recorded over the past two years but never had time to complete. My goal as always is to produce episodes on a regular basis and hope to get some support at my new academic institution.

In this episode, I talk with Florent Aptel, a glaucoma specialist in Grenoble, France, about his work in developing a modern day hi frequency ultrasound as a treatment for glaucoma in its early stages. Their group has developed a device that selectively focuses the energy on the ciliary body without collateral damage that offers hope as a future treatment modality.

This episode was recorded live in March 2012 during the Glaucoma Today 2012 conference in Tel Aviv, Israel, using a Shure SM58 microphone with a Marantz PMD661 digital recorder. Mixing and sound levelling were performed in January 2014 on a MacBook Pro and MacPro using Levelator, Fission, and Garage Band. Narration was overdubbed using a Heil PR40 Microphone and Garage Band.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

]]>Schertzer & AptelHi Frequency Ultrasound (HiFU) for early glaucoma - a promising future treatmentIn this episode, I talk with Florent Aptel, a glaucoma specialist in Grenoble, France, about his work in developing a modern day hi frequency ultrasound as a treatment for glaucoma in its early stages. Their group has developed a device that selectively focuses the energy on the ciliary body without collateral damage that offers hope as a future treatment modality.no00:10:27TAG Episode 21 - 26Feb2013: Laser Iridotomy (AAC Enhanced)PodcastGlaucomaRob SchertzerTue, 26 Feb 2013 19:30:56 +0000http://wholelottarob.com/tag-aac/2013/2/26/tag-episode-21-26feb2013-laser-iridotomy-aac-enhanced5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:512d00e0e4b05898bcb4ce28In this episode, Dr Blumenthal and I discuss the not so obvious technique
of peripheral laser iridotomy, emphasizing the shift away from the 12
o'clock position to a temporal location for most patients. We discuss the
rationale for this shift, that includes the dramatic reduction in
photopsias, as well as some tips and tricks in performing this technique.In this episode, Dr Blumenthal and I discuss the not so obvious technique of peripheral laser iridotomy, emphasizing the shift away from the 12 o'clock position to a temporal location for most patients. We discuss the rationale for this shift, that includes the dramatic reduction in photopsias, as well as some tips and tricks in performing this technique.

This episode was recorded live in June 2011 during the joint meeting of the Canadian Glaucoma Society and the Canadian Ophthalmological Society annual meeting using a Shure SM58 microphone with a Marantz PMD661 digital recorder. It is finally seeing the light of day after I've been side-tracked with too many other projects. Mixing, editing, and sound levelling were completed in February 2013 on a MacPro, MacBook Pro and MacBook Air using Levelator, Fission, and Garage Band. Narration was overdubbed using a Blue Microphone Yeti and a Heil PR40 Microphone. Final editing was completed February 2013.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

]]>Schertzer & BlumenthalnoTAG Episode 20 - 3Jan2013: Excimer Laser Trabeculostomy (AAC enhanced)PodcastGlaucomaRob SchertzerThu, 03 Jan 2013 06:15:45 +0000http://wholelottarob.com/tag-aac/2013/1/2/tag-episode-20-3jan2012-excimer-laser-trabeculostomy5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:50e4b0cce4b0251241110cdfIn this episode, Dr Berlin and I discuss the elusive quest to have the
Excimer Laser Trabeculostomy (ELT) that he pioneered gain traction after 30
years of development. (This is the AAC enhanced version with chapter
markers and images optimized for iOS devices and computers; see mp3 version
for most other devices.)In this episode, Dr Berlin and I discuss the elusive quest to have the Excimer Laser Trabeculostomy (ELT) that he pioneered gain traction after 30 years of development. (This is the AAC enhanced version with chapter markers and images optimized for iOS devices and computers; see mp3 version for most other devices.)

This episode was recorded live in March 2011 during the American Glaucoma Society annual meeting using a Shure SM58 microphone with a Marantz PMD661 digital recorder. It is finally seeing the light of day after I've been side-tracked with too many other projects. Mixing and sound levelling were completed in June 2012 on a MacPro, MacBook Pro and MacBook Air using Levelator, Fission, and Garage Band. Narration was overdubbed using a Heil PR40 Microphone. Final editing was completed December 2012.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.--------------------------------------------------Selected references:

]]>Michael Berlin & Rob SchertzernoTAG Episode 19 - Bleb Needling: Slit Lamp Revision (AAC Enhanced)GlaucomaRob SchertzerMon, 06 Feb 2012 02:43:21 +0000http://wholelottarob.com/tag-aac/2012/2/5/tag-episode-19-bleb-needling-slit-lamp-revision-aac-enhanced.html5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:505a5112e4b07fcb9617e088In this episode, Dr Solish and I discuss the art of “needling” a filtering
bleb, or as he likes to call it, a Slit Lamp Revision (SLR), to resuscitate
its function. Beginning with the history of when he first thought of the
idea as a resident and it was shot down and how this evolved to using
antimetabolites in conjunction with the needling in order to discourage
fibroblasts from forming more scar tissue from the procedure. You might be
surprised to learn what types of blebs are more likely to improve with Slit
Lamp Revision!In this episode, Dr Solish and I discuss the art of “needling” a filtering bleb, or as he likes to call it, a Slit Lamp Revision (SLR), to resuscitate its function. Beginning with the history of when he first thought of the idea as a resident and it was shot down and how this evolved to using antimetabolites in conjunction with the needling in order to discourage fibroblasts from forming more scar tissue from the procedure. You might be surprised to learn what types of blebs are more likely to improve with Slit Lamp Revision!

This episode was recorded live in March 2011 during the American Glaucoma Society annual meeting using a Shure SM58 microphone with a Marantz PMD661 digital recorder. Mixing and sound levelling were completed in February 2012 on a MacPro, MacBook Pro and MacBook Air using Levelator, Fission, and Garage Band. Narration was overdubbed using a Heil PR40 Microphone.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

Dr. Krishna is Board Certified in Ophthalmology and Fellowship trained in glaucoma. He completed his ophthalmology residency at the Cleveland Clinic Foundation in Cleveland, Ohio, where he also served as Chief Resident. He completed his glaucoma subspecialty training at the prestigious Bascom Palmer Eye Institute in Miami, Florida. He was honored as a recipient of a scholarship from the Heed Foundation during his fellowship. He is actively involved in resident and medical student education and research at the Eye Foundation of Kansas City, Truman Medical Center and Department of Ophthalmology, University of Missouri-Kansas City (UMKC) School of Medicine. He is Director of the Glaucoma service and Associate Professor of Ophthalmology at the University of Missouri - Kansas City (UMKC) School of Medicine. Dr. Krishna has published book chapters and numerous articles in the areas of his expertise. He is a partner at Sabates Eye Centers and Medical Director/CEO at Epic Surgery Centers.(All biographical information taken from the Eye HandBook website)

This episode was recorded live in March 2011 during the American Glaucoma Society annual meeting using a Shure SM58 microphone with a Marantz PMD661 digital recorder. Mixing and sound levelling were performed in November 2011 on a MacPro, MacBook Pro and MacBook Air using Levelator, Fission, and Garage Band. Narration was overdubbed using a Heil PR40 Microphone and Garage Band.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

]]>Ro Krishna & Rob SchertzernoTAG Episode 17 - 10Aug2011: Ologen enhanced Glaucoma Surgery with Steve Sarkisian (AAC Enhanced)GlaucomaRob SchertzerWed, 10 Aug 2011 05:15:15 +0000http://wholelottarob.com/tag-aac/2011/8/9/tag-episode-17-10aug2011-ologen-enhanced-glaucoma-surgery-wi.html5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:505a5112e4b07fcb9617e080In this episode, Dr Sarkisian and I discuass his use of Ologen branded
collagen matrix in attempts to improve the success of glaucoma surgery.
This novel modification has yet to gain widespread support and would still
be considered experimental at the time of this recording.In this episode, Dr Sarkisian and I discuass his use of Ologen branded collagen matrix in attempts to improve the success of glaucoma surgery. This novel modification has yet to gain widespread support and would still be considered experimental at the time of this recording.

Steven R. Sarkisian, Jr., MD is the director of the glaucoma fellowship at the Dean A. McGee Eye Institute and serves as a clinical associate professor of Ophthalmology at the University of Oklahoma in Oklahoma City. Dr Sarkisian has a special interest in nanotechnology applications for the treatment of glaucoma; innovation in glaucoma surgery; and glaucoma drainage devices.

This episode was recorded live in March 2011 during the American Glaucoma Society annual meeting using a Shure SM58 microphone with a Marantz PMD661 digital recorder. Mixing and sound levelling were performed on a MacBook Pro and MacBook Air using Levelator, Fission, and Garage Band. Narration was overdubbed using a Blue Microphone Yeti through Audio HiJack on a MacPro.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care. —————————————————————————Selected reference:New Methods and Modifications of Glaucoma Filtration SurgerySarkisian, Steven R. Jr MD; Rouse, J. Matthew MD International Ophthalmology Clinics:Summer 2011 - Volume 51 - Issue 3 - p 95–106More references on the media center section at the Ologen website:http://www.oculusgen.com/page02-04.php

In this episode, Dr De Moraes and I discuss risk factors for visual field progression in patients already diagnosed with and being treated for glaucoma.

Dr De Moraes’ group found that patients with established glaucoma were more likely to progress when peak IOP was 18 mm Hg (millimeters of mercury) or higher. Other risk factors included thinning of the cornea, presence of disc hemorrhage in the retina of the eye, and atrophy in part of the eye.

This study was supported by the Joseph and Geraldine LaMotta Research Fund of the New York Glaucoma Research Institute, and one investigator’s work was supported by the Glaucoma Research and Education Fund of Lenox Hill Hospital; both institutions are located in New York. Please see the article in Archives of Ophthalmology cited in these notes for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support.

Dr Gustavo De Moraes is Associate Professor of Ophthalmology at the New York University School of Medicine.

This episode was recorded live in March 2011 during the American Glaucoma Society annual meeting using a Shure SM58 microphone with a Marantz PMD661 digital recorder. Mixing and sound levelling were performed on a MacBook Pro and MacBook Air using Levelator, Fission, and Garage Band. Narration was overdubbed using a Blue Microphone Yeti.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

This episode was recorded using more brand new and fun recording gear! Namely, a Marantz PMD-661 Digital recorder and a Shure SM-58 microphone. Voice overs were done using a Blue Microphones YETI and mix down on a MacBook Air and MacBook Pro using Garage Band ‘11.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

]]>Josh Ehrlich & Rob SchertzernoTAG Episode 14 - 21Feb2011: New glaucoma devices with Dale Heuer (AAC Enhanced)GlaucomaRob SchertzerMon, 21 Feb 2011 13:00:05 +0000http://wholelottarob.com/tag-aac/2011/2/21/tag-episode-14-21feb2011-new-glaucoma-devices-with-dale-heue.html5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:505a5111e4b07fcb9617e071In this episode, Dr Dale Heuer and I discuss the latest glaucoma surgical
techniques and devices in search of solid evidence for their safety and
effecacy. Trabeculectomy is the operation that we love to hate so we are
always looking for something better. In some countries, new devices just
require proving safety without having to show efficacy whereas in other
countries both must be proven.In this episode, Dr Dale Heuer and I discuss the latest glaucoma surgical techniques and devices in search of solid evidence for their safety and effecacy. Trabeculectomy is the operation that we love to hate so we are always looking for something better. In some countries, new devices just require proving safety without having to show efficacy whereas in other countries both must be proven. Canaloplasty involves threaded a fibre-optic canula around the full circumference of Schlemm’s canal, using viscoelastic to then dilate the canal, pull a suture through to tighten it and change the canal’s position, then creating a descemet’s window before closing. The ExPress mini-shunt is a metal tube under a trabeculectomy scleral flap to create a more predictable trab. The trabectome removes the trabecular meshwork with cautery. The iStent implant is a metal snorkle creating a direct communication between the anterior chamber and Schlemm’s canal. An ER:YAG laser technique of creating direct communication between the AC and the canal has been pioneered by Dr MIchael Berlin but has still not gained traction. Other blebless techniques including the SOLEX gold plate used to create a cyclodialysis are still being tried. In the end, we still have our proven trabeculectomy as well as tube-shunt glaucoma drainage devices, both of which we have solid evidence of safetly and efficacy.

As an addendum, during the show I mentioned that I was going to be performing canaloplasty in the future. I have now performed three surgeries and have three more booked for March 2011. The procedure is like angioplasty for the eye compared with a trabeculectomy or other bleb forming surgeries that are more like bypass surgeries. There is also 4 year data showing canaloplasty success with IOP lowering >30% so this does show some promise as one of the new surgeries though it is technically a bit more complicated despite being less invasive than a trab.————————————Dale K. Heuer, MDProfessor & Chairman, Department of OphthalmologyMedical College of WisconsinDirector, Eye InstitutePhone: (414) 955-2020FAX: (414) 955-6300E-mail: dheuer@mcw.eduThe Eye Institute925 N. 87th St.Milwaukee, WI. 53226 http://www.mcw.edu/ophthalmology/faculty/FacultyProfiles1/DaleKHeuerMD.htm————————————This episode was recorded at the West Coast Glaucoma Centre in Vancouver, BC, on November 19, 2010. The recording gear for this episode included the Blue Microphones YETI, MacPro, Iomega SSD Flash external drive and Audio Hijack Pro software. Fission was used to convert the audio file to AIFF for Levelator to balance the sound levels. The final audio editing, chapter markers, show notes and images were put together using Garage Band ‘11 on an 11” MacBook Air. I have a lot of fun doing this by myself and recording these interviews with my colleagues. Look for more episodes as I still have another couple that are recorded that I have to edit.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

]]>Dale Heuer & Rob SchertzernoTAG Episode 13 - 6Dec2010: Glaucoma risk factors with Marcelo Nicolela (AAC Enhanced)GlaucomaRob SchertzerFri, 03 Dec 2010 17:27:18 +0000http://wholelottarob.com/tag-aac/2010/12/3/tag-episode-13-6dec2010-glaucoma-risk-factors-with-marcelo-n.html5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:505a5111e4b07fcb9617e06dIn this episode, Dr Nicolela and I discuss the risk factors for the
development of glaucoma. This includes talking about the difference between
risk factors for developing disease vs those for disease to progress. Much
of our current knowledge is based on information from clilnical trials and
population studies over the past decade. Bear in mind that still
intraocular pressure remains as the single most important modifiable risk
factor, even in normal tension glaucoma patients.Show notes Talking About Glaucoma #13 December 2010 Glaucoma Risk Factors

In this episode, Dr Nicolela and I discuss the risk factors for the development of glaucoma. This includes talking about the difference between risk factors for developing disease vs those for disease to progress. Much of our current knowledge is based on information from clilnical trials and population studies over the past decade. Bear in mind that still intraocular pressure remains as the single most important modifiable risk factor, even in normal tension glaucoma patients.

Some of the risk factors discussed include intraocular pressure (IOP), age, race (african americans and U.S. Latinos), pachymetry (corneal thickness), family history, and low perfusion pressure as well as signs that likely represent early manifestation of the disease itself such as vertical disc cupping and disc haemmorhages.

Dr Nicolela is Associate Professor and Fellowship Director in the Department of Ophthalmology & Visual Sciences at Dalhousie University.

This episode was recording during the Canadian Ophthalmogical Society 2010 Annual Meeting in Quebec City. The recording gear for this episode included the Blue Microphones YETI, MacBook Pro 2010 15.4”, LaCie Rugged External Drive and Audio Hijack Pro software. Fission was used to convert the audio file to AIFF for Levelator to balance the sound levels. The final audio editing, chapter markers, show notes and images were put together using Garage Band ‘11. I have a lot of fun doing this by myself and recording these interviews with my colleagues. Look for more episodes as I still have another couple that are recorded that I have to edit.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

Mr Paul Foster a consultant glaucoma specialist with a particular interest in angle-closure glaucoma. He runs the only specialist clinic for angle-closure glaucoma in Europe at Moorfields Eye Hospital. He has had extensive clinical and research training in glaucoma in London, Oxford and Singapore.

Mr Foster’s primary research interests concern the epidemiology (the distribution, risk factors and control) of glaucoma and myopia, with a special interest in the detection, prevention and treatment of angle-closure glaucoma. I am currently running several randomised clinical trials on management of angle-closure glaucoma. I am also collaborating with colleagues at Cambridge University and The Norfolk and Norwich University Hospital to run a study of eye disease in 10,000 people in East Anglia (The EPIC Norfolk Eye Study) which aims to give information about the impact of lifestyle, environment, diet and genetics on major age-related eye diseases in the UK.

This episode was recording in Quebec City on June 28, 2010 during the annual meeting of the Canadian Ophthalmological Society using the Blue Microphone Yeti on a MacBoook Pro computer. Levelator was used to level the sound levels then the final mix was performed with Garage Band which also allowed embedding images in the AAC version.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

]]>Paul Foster & Rob SchertzernoTAG Episode 11 - Mar 18, 2010 Schuman & Burgoyne Imaging (AAC Enhanced)GlaucomaRob SchertzerThu, 18 Mar 2010 12:30:43 +0000http://wholelottarob.com/tag-aac/2010/3/18/tag-episode-11-mar-18-2010-schuman-burgoyne-imaging-aac-enha.html5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:505a5111e4b07fcb9617e065n this episode, Drs Schuman, Burgoyne and I discuss optic nerve and nerve
fiber layer iimaging in glaucoma. To clarify the different modalities, the
Confocal Scanning Laser Ophthalmoscope (CSLO) has been popularized as the
Heidelberg Engineering device, current version being the HRT 3; the
Scanning Laser Polarimeter is the GDx machine, and; the original Optical
Coherence Tomography unit and its next 2 generations were popularized by
Zeiss and use Time Domain scanning whereas the latest technology uses
Spectral Domain technology to achieve much higher resolution with the
Spectralis OCT made by Heidelberg Engineering.In this episode, Drs Schuman, Burgoyne and I discuss optic nerve and nerve fiber layer iimaging in glaucoma. To clarify the different modalities, the Confocal Scanning Laser Ophthalmoscope (CSLO) has been popularized as the Heidelberg Engineering device, current version being the HRT 3; the Scanning Laser Polarimeter is the GDx machine, and; the original Optical Coherence Tomography unit and its next 2 generations were popularized by Zeiss and use Time Domain scanning whereas the latest technology uses Spectral Domain technology to achieve much higher resolution with the Spectralis OCT made by Heidelberg Engineering.

Dr. Schuman is at University of Pittsburgh Medical Centre and is an inventor of Time Domain Ocular Coherence Tomography. His research interests include imaging of the eye, laser-tissue interactions, aqueous outflow, and clinical pharmacology.

This episode was recorded February 26, 2010 with Rob Schertzer using a Blue Snowball Mic on a MacPro running HiJack Pro with Joel and Claude connected over Skype from Pittsburgh and Portland. Levelator was used to compress the sound pressure level and the final editing was performed in March 2010 with Garage Band on a MacBook Pro. Editing was completed on 17Mar2010.

—————————————————————————Selected references:No specific journal articles are referenced in this episode.

]]>Joel Schuman, Paul Burgoyne & Rob SchertzernoTAG Episode 10 - Jan 19, 2010 w/ Karim Damji discussing SLT (AAC Enhanced)GlaucomaRob SchertzerWed, 20 Jan 2010 05:20:35 +0000http://wholelottarob.com/tag-aac/2010/1/19/tag-episode-10-jan-19-2010-w-karim-damji-discussing-slt-aac.html5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:505a5111e4b07fcb9617e061In this episode, Dr Damji and I discuss the use of Selective Laser
Trabeculoplasty (SLT) in treating patients with open angle glaucoma. The
conversation includes a comparison of this to Argon Laser Trabeculoplasty
(ALT), the step-wise approach to treating patients with glaucoma and where
the SLT might fit it. We also cover the burning question of the
repeatability of this treatment modality as well as its contraindications.

Dr Damji is Professor, Department of Ophthalmology, University of Alberta. His recent research topics include Pseudoexfoliation Glaucoma, SLT vs medications as first line glaucoma therapy, and whether SLT treatment reduces diurnal variation of intraocular pressure (IOP.)

Karim Damji, MD, FRCSC, MBA

Professor

Department of Ophthalmology

University of Alberta

2317, 10240 Kingsway Avenue

Edmonton, AB T5H 3V9

Tel: 780.735.4200

Fax: 780.735.5242

This episode was recording using Skype on December 3, 2010 and mixed in January 2010. After much delay it ws finally posted on January 20, 2010. Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

]]>Karim Damji & Rob SchertzernoTAG Episode 9 - Nov 22, 2009 (AAC version)GlaucomaRob SchertzerMon, 23 Nov 2009 14:20:25 +0000http://wholelottarob.com/tag-aac/2009/11/23/tag-episode-9-nov-22-2009-aac-version.html5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:505a5111e4b07fcb9617e05cIn this episode, Dr Hom and I discuss things to consider in purchasing a
Visual Field machine for your practice. We look at the choice based on the
scope of your practice, networking, and sharing your data with colleagues.In this episode, Dr Hom and I discuss things to consider in purchasing a Visual Field machine for your practice. We look at the choice based on the scope of your practice, networking, and sharing your data with colleagues.

Dr. Hom has over 25+ years of medical optometric eye care. From 2002-2006, he served as the Coordinator, Primary Care Optometry, San Mateo Medical Center. In that capacity, he managed a broad range of eye problems from refractive to medical. He has significant experience in managing diabetic retinopathy and was key in establishing one of the state’s first demonstration project for the screening of diabetics with digital retinal photography for retinal eye disease. From 1984-1999, Dr Hom was a low vision and specialty contact lens consultant for Kaiser’s San Francisco Medical Center.

His varied career brought him to a passion for access and language competency in health care. He also has a deep interest in cultural and language competency in medical care.

This episode was recorded November 11, 2009 over the internet using Skype and the mix was finalized on November 22, 2009.--------------------------------------------------Selected references:No specific journal articles are referenced in this episode. We do refer you to your local vendor of ophthalmic instruments in helping you in your decision on what type of Visual Field device best suits your practice and hope this discussion helps guide you in the right direction.

]]>Richard Hom & Rob SchertzernoTAG Episode 8 - Sep 7, 2009GlaucomaRob SchertzerTue, 08 Sep 2009 05:50:52 +0000http://wholelottarob.com/tag-aac/2009/9/7/tag-episode-8-sep-7-2009.html5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:505a5111e4b07fcb9617e058In this episode, Dr Hutnik and I discuss Central Corneal Thickness (CCT)
and its use as PART of the assessment of patients at risk of glaucoma.In this episode, Dr Hutnik and I discuss Central Corneal Thickness (CCT) and its use as PART of the assessment of patients at risk of glaucoma.

Dr. Hutnik completed doctorate work at the National Research Council of Canada in Ottawa prior to her medical training at the University of Ottawa. This was followed by ophthalmic training at the University of Western Ontario and the University of Wisconsin, Madison, the latter under the mentorship of Dr. Paul Kaufman. Dr. Hutnik has a full-time clinical glaucoma practice at the Ivey Eye Institute in London, Ontario where she is involved in the clinical training of residents and medical students. She is a member of the international Tear Film and Ocular Surface committee of the Association for Research in Vision.

Dr. Hutnik is Medical Coordinator of the ophthalmic basic science laboratory at the Lawson Health Research Institute in London and supervises an independent program of both clinical and basic science research. Dr. Hutnik’s research administrative roles include membership on the Board of Directors of the Lawson Health Research Institute and Chair of the Summer Research Training Program at the University of Western Ontario. The latter fosters an interest in, and aptitude for, research in junior medical students. In addition to the supervision of medical student and resident research, Dr. Hutnik is involved with the supervision of 4th Honours Thesis students in the Department of Pathology as well as keen secondary school students through various Co-op programs.

This episode was recording in Toronto in late June 2009 with editing completed September 7, 2009 in Vancouver, BC.

]]>CIndy Hutnik & Rob SchertzernoTAG Episode 7 - Aug 2, 2009GlaucomaRob SchertzerMon, 03 Aug 2009 04:04:59 +0000http://wholelottarob.com/tag-aac/2009/8/2/tag-episode-7-aug-2-2009.html5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:505a5111e4b07fcb9617e054In this second part of a two part conversation, we discuss the risk factors
for progression in Normal Tension Glaucoma as determined by the Normal
Tension Glaucoma Study.In this second part of a two part conversation, we discuss the risk factors for progression in Normal Tension Glaucoma as determined by the Normal Tension Glaucoma Study.

Stephen Drance, MD, FRCSC, is Professor Emeritus UBC Ophthalmology & Visual Sciences and an Officer of the Order of Canada. He was the co-lead investigator for the Normal Tension Glaucoma studies, popularized the importance of disc hemorrhages in glaucoma which bear his name, and has made many other contributions to much of our current understanding of glaucoma. He has published 10 books, 14 book chapters, and 358 articles on Glaucoma. At the local level, he founded the UBC Eye Care Centre and Festival Vancouver. These recordings were made at the home of Stephen & Betty Drance in June, 2009.—————————————————————————Selected references:Collaborative Normal-Tension Glaucoma Study Group.Natural History of Normal Tension Glaucoma. Ophthalmology 108; 247-253,2001

]]>Stephen Drance & Rob SchertzernoTAG Episode 6 - July 8, 2009Rob SchertzerThu, 09 Jul 2009 04:31:00 +0000http://wholelottarob.com/tag-aac/2009/7/8/tag-episode-6-july-8-2009.html5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:505a5111e4b07fcb9617e050In this episode, we discuss the role of Intraocular Pressure (IOP) in
Normal Tension Glaucoma & the natural history of the condition as
determined in the Normal Tension Glaucoma Study. Stephen Drance, MD, FRCSC,
is Professor Emeritus UBC Ophthalmology & Visual Sciences and an Officer of
the Order of Canada. He was the co-lead investigator for the Normal Tension
Glaucoma studies, popularized the importance of disc hemorrahges in
glaucoma which bear his name, and has made many other contributions to much
of our current understanding of glaucoma.In this episode, we discuss the role of Intraocular Pressure (IOP) in Normal Tension Glaucoma & the natural history of the condition as determined in the Normal Tension Glaucoma Study. Stephen Drance, MD, FRCSC, is Professor Emeritus UBC Ophthalmology & Visual Sciences and an Officer of the Order of Canada. He was the co-lead investigator for the Normal Tension Glaucoma studies, popularized the importance of disc hemorrahges in glaucoma which bear his name, and has made many other contributions to much of our current understanding of glaucoma. He has published 10 books, 14 book chapters, and 358 articles on Glaucoma. At the local level, he founded the UBC Eye Care Centre and Festival Vancouver. These recordings were made at the home of Stephen & Betty Drance in June, 2009.

Part 2 of this podcast will examine the relationship between the normal tension glaucoma risk factors and the natural history of the disease.

]]>Stephen Drance & Rob SchertzernoTAG episode 5 - May 7, 2009Rob SchertzerFri, 08 May 2009 04:29:00 +0000http://wholelottarob.com/tag-aac/2009/5/7/tag-episode-5-may-7-2009.html5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:505a5111e4b07fcb9617e04cWe discuss lessons learned from putting the Disc Damage Likelihood Scale
(DDLS) into clinical practice and the importance of looking at the
neuroretinal rim - not the cup. Also, the George Spaeth concept that you
only see what you look for and look for what you know.We discuss lessons learned from putting the Disc Damage Likelihood Scale (DDLS) into clinical practice and the importance of looking at the neuroretinal rim - not the cup. Also, the George Spaeth concept that you only see what you look for and look for what you know. Jeffrey D. Henderer, MD http://tinyurl.com/qye6hw Dr. Edward Hagop Bedrossian Chair & Professor, Department of Ophthalmology Temple University School of Medicine Telephone: 215-707-3185 Email: jeffrey.henderer@temple.edu Trans. Am. Ophthalmol. Soc. Vol. 100, 2002 (DDLS publication) http://tinyurl.com/yo6slu

]]>Jeff Henderer & Rob SchertzernoTAG Episode 4 - April 16, 2009Rob SchertzerFri, 17 Apr 2009 04:26:00 +0000http://wholelottarob.com/tag-aac/2009/4/16/tag-episode-4-april-16-2009.html5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:505a5111e4b07fcb9617e048Vascular problems related to glaucoma; a discussion with Mark Lesk, MD,
PhD, FRCSC, Associate Professor Universite de Montreal and director of
Ophthalmology research at Maisonneuve-Rosemont Hospital.Vascular problems related to glaucoma; a discussion with Mark Lesk, MD, PhD, FRCSC, Associate Professor Universite de Montreal and director of Ophthalmology research at Maisonneuve-Rosemont Hospital. (http://recherche.maisonneuve-rosemont.org/en-ca/research/our-research-investigators/lesk-mark.html) The focus of this discussion is on research on systemic vascular endothelial dysfunction and how this pertains clinically to glaucoma. The balance between vasodilation from nitric oxide and vasoconstriction from endothelin-1.

]]>Michael Coote & Rob SchertzernoTAG Episode 2 - March 16, 2009Rob SchertzerTue, 17 Mar 2009 04:19:00 +0000http://wholelottarob.com/tag-aac/2009/3/16/tag-episode-2-march-16-2009.html5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:505a5111e4b07fcb9617e041Dr. Gustavo De Moraes, Glaucoma Research Fellow New York Eye and Ear
Infirmary, talks with Dr. Robert Schertzer about the 62% increased risk of
glaucoma progressing when defects are present in both the superior and
inferior hemi-fields vs a defect in a single hemi-field.Dr. Gustavo De Moraes, Glaucoma Research Fellow New York Eye and Ear Infirmary, talks with Dr. Robert Schertzer about the 62% increased risk of glaucoma progressing when defects are present in both the superior and inferior hemi-fields vs a defect in a single hemi-field.

]]>Gus De Moraes & Rob SchertzernoTAG Episode 1 - March 11, 2009Rob SchertzerThu, 12 Mar 2009 02:18:00 +0000http://wholelottarob.com/tag-aac/2009/3/11/tag-episode-1-march-11-2009.html5005e86f84aedff146247c35:505a5111e4b07fcb9617e03b:505a5111e4b07fcb9617e03d'TAG,' Talking About Glaucoma, a regular podcast hosted by Robert M.
Schertzer, MD, MEd, FRCSC talking with colleagues about topics of interest
in the ophthalmology subspecialty area of glaucoma. The inaugral episode
introduces an upcoming series of podcasts from the annual American Glaucoma
Society meeting being held March 5-8, 2009 in San Diego.'TAG,' Talking About Glaucoma, a regular podcast hosted by Robert M. Schertzer, MD, MEd, FRCSC talking with colleagues about topics of interest in the ophthalmology subspecialty area of glaucoma. The inaugral episode introduces an upcoming series of podcasts from the annual American Glaucoma Society meeting being held March 5-8, 2009 in San Diego.